All rights reserved. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Tears are typically vertical in young patients and horizontal in the elderly (Figure 5). Displaced meniscal tears are by definition unstable, and should be repaired relatively quickly, as displaced meniscal fragments may fibrose and distort, making delayed repair difficult or impossible. In contrast, the inner two-thirds of the meniscus lacks a significant blood supply. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. Orthopaedic Basic Science: Foundation of Clinical Practice. [Epub ahead of print]. We believe these tears are more degenerative in nature, and there is no evidence to support that by repairing these medial meniscal root tears, knee degeneration will be postponed or stopped. 11 Plain radiography is only useful to exclude differentials and computed tomography (CT) is markedly inferior to MRI for meniscal imaging.12 Magnetic resonance imaging is the gold standard, first choice for investigation of suspected meniscal tears.2,1316. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. Great Britain: Hodder Arnold, 2005. The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. what is the treatment? Short description: Oth meniscus derang, post horn of medial meniscus, l knee The 2023 edition of ICD-10-CM M23.322 became effective on October 1, 2022. Meniscus Surgery. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. When small, conservative therapy or simply rasping the meniscus may result in healing of these tear types. I read on a medical site that it is difficult to get to the posterior horn of the meniscus and sometimes there is a need to make an incision or the knee becomes dislocated. Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. Although the . Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. If you have unusual pain and discomfort in your knee, let us help you get back to doing the things you love. Many meniscus tears will not need immediate surgery. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. Age of injury peaks at 2029 years.7 Partial meniscectomy (removal of the torn section) is one of the most commonly performed orthopaedic surgical procedures.8. Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. Lateral meniscus is intact. Disclosures: Blake and Johnson report no relevant financial disclosures. Be unable to extend your leg comfortably and may feel better when your knee is bent (flexed). The MRI revealed a vertical flap (oblique) tear of the medial meniscus. AJR 2000; 174:161-164. Know why a new medicine or treatment is prescribed, and how it will help you. Guides you through the decision to have surgery for a torn meniscus. ICD 9 Codes: 717.4 derangement of the lateral meniscus 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: Functional Anatomy: The menisci are semi lunar shaped cartilages on the medial and lateral sides of the knee joint. The meniscus is a piece of C-shaped cartilage that helps cushion the knee. Because a torn meniscus is made of cartilage, it won't show up on X-rays. Nonsurgical treatment is an option for elderly patients, those with significant comorbidities and those with advanced OA (Outerbridge grade 3 or 4 chondromalacia of the ipsilateral compartment). Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. The surgeon then inserts surgical instruments through two or three other small portals to trim or repair the tear. Incisions were made in the dorsal root of the oblique popliteal ligament and the joint capsule . Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. If the test is positive (suggesting a meniscal tear), the patient will feel pain and the clinician will feel and/or hear meniscal movement when the meniscus is compressed between the tibia and femur 32, Figure 2. The first one is traumatic and the second one is a degenerative meniscal tear. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. w/severe pain? Fat suppressed proton density-weighted (15a) coronal and (15b) sagittal images reveal a tibial sided flap tear of the body of the medial meniscus, with displacement of the undersurface component (arrows) into the inferior gutter. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . Types of meniscus tears:(Left) Bucket handle tear. Rehabilitation time for a meniscus repair is about 3 to 6 months. A high level of suspicion is required to detect these injuries, and repair is recommended to preserve joint function. 13 Newman AP, Daniels AU, Burks RT. growth factors) on meniscus tissue is being investigated.2 These are currently only being trialled in younger patients7 and the routine use of most of these technologies is some time away. How can I tell if I have an oblique fracture? Radiographs may or may not show medial joint space narrowing. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. A comparative study with a short term follow up. These tears often require surgical treatment to restore the proper function of the knee. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. Identification of a meniscal root tear on MRI may be challenging due to the relatively small size of the root. A loose piece of cartilage can get stuck in the joint, causing the knee to temporarily lock, preventing full extension of the leg. (11a) A 3D illustration of a bucket handle tear demonstrates that these tears actually are longitudinal in nature (arrows), coursing parallel to the c-shaped fibers of the meniscus. Explains when surgery is done. This part of the tibia is also known as the tibial plateau. Athletes, particularly those who play contact sports, are at risk for meniscus tears. The medial meniscus is C-shaped, while the lateral meniscus is more . The meniscus is broken down into the outer, middle, and inner thirds. A case also can be made for medial meniscal root repairs for a symptomatic acute and possibly a chronic medial meniscal root tear in a non-obese patient older than 40 years with a MRI that does not have early arthritic changes. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen help reduce pain and swelling. The medial meniscus is the cushion that is located on the inside part of the knee. OKeefe R, et al. Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. pivoting). The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. Intrasubstance/incomplete tear (top left) This type of tear is often a sign of degenerative changes in the meniscus tissue. The joint is fairly flexible only the last 10-15 degrees is painful, but the pain on walking constant and vulnerable to . American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. AJR Am J Roentgenol 1998;170:5761. The identification of the meniscus comma sign . Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. Can a torn meniscus heal by itself? If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. At The Orthopedic Clinic, we want you to live your life in full motion. swelling . All rights reserved. Harrison BK, Abell BE, Gibson TW. These are paraphrased. Orthopedics 2009;32:8. Your doctor may inject a corticosteroid medication into your knee joint to help eliminate pain and swelling. Weakness, grinding, instability or giving way rarely result from meniscal pathology. Displacement of the inner rim of the tear (arrowheads) results in the classic "bucket-handle" configuration. An experimental study in dogs. (10a) A GRE T2*-weighted sagittal image reveals a complex tear of the posterior horn of the medial meniscus, having horizontal (arrows) and longitudinal (arrowhead) components. Ask if your condition can be treated in other ways. This most often happens when the tear develops over a period of time. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Scuderi G, Tria A. If the knee is still painful, or if it locks, your doctor may recommend surgery. Because there is no supply, there is little capacity for these tears to heal on their own. I have an oblique tear of the posterior horn of the medial meniscus, what is the treatment for that? If the tear cant be repaired, occasionally the meniscus can be surgically trimmed. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. Now, 49 I have had intense pain 2 days after a 3 hour steep mountain walk- the first in 6 months. The menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Two months later, the post-operative image (17b) reveals a repaired, normal appearing lateral meniscal body (arrow), with resolution of the previously seen displaced fragment. McMurray (Figure 1) and Apley tests (Figure 2) are often positive, although these are specific but not sensitive specificity being 5798% and 8099%, and sensitivity being 1066% and 1658% respectively.2,9 The most useful clinical test for meniscal injury is the Thessaly test, which is demonstrated in Figure 3. (8a) The curvilinear course of oblique tears often results in abnormal vertical signal (arrows) that progresses towards or away from the free edge of the meniscus on consecutive images, as seen in these sequential images of an oblique tear (arrows) of the posterior horn of the medial meniscus. This type of tear is particularly devastating to meniscal function. New advances in musculoskeletal pain. Imaging tests X-rays. The clinician applies axial pressure to the foot and rotates the tibia internally and externally. (14a) A 3D depiction of a flap tear of the posterior body of the medial meniscus illustrates displacement of the upper component of the flap (arrow) from its site of origin. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. There are numerous types of meniscus tears, including: This type of tear is often a sign of degenerative changes in the meniscus tissue. Collateral and cruciate ligaments are intact. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. MR imaging: effectiveness and costs at triage of patients with nonacute knee symptoms. Over 2 to 3 days, however, the knee will gradually become more stiff and swollen. 2 Jaureguito JW, Elliot JS, Lietner T. The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional, clinical, and radiographic results. Although the pain improved, the patient could not flex her knee joint deeply. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. Damaged avascular meniscus must be removed.27 However, meniscectomy causes long term osteoarthritis,28 so is only performed when the patient suffers joint locking or mensical pain that is refractory to conservative management. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. Repair is sometimes attempted even with these tear types, particularly when the patient is young and substantial loss of meniscal tissue would lead to an unacceptable risk of future arthritis.11 Repair of these challenging tear types should only be attempted when the meniscal tissue is of good quality and a stable result is achievable. This extrusion should disappear without stress. Sometimes conservative treatment doesnt work. AnteroLateral Meniscus Tear: This means your lateral meniscus is torn and in a location on the front portion of the knee. There will also be skin discoloration and visible deformity at the site of the injury. The best known displaced tear that is amenable to repair is the bucket-handle tear. In addition to the root tear, the MRI often shows chondral loss or fissuring, other areas of meniscal tearing, bone marrow edema or osteophyte formation (Figure 5). Medial Meniscus: oblique tear of the posterior portion with a separated and unstable fragment. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. 10 DeHaven KE. Knee Surg Sports Traumatol Arthrosc 2011 Aug 11. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. Clinical outcomes following isolated lateral meniscal allograft transplantation. Clin J Sport Med 2009;19:912. As recognition of the critical function of the menisci in normal biomechanical function of the knee has grown, attempts at preserving meniscal tissue via repair as opposed to partial meniscectomy have also gained favor. AJR 2001; 176:771-776. Helms CA, Laorr A, Cannon WD, Jr. A lateral meniscus tear (torn meniscus) is a tear of the semicircular fibrous cartilage discs in the knee. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. Meniscal injury is common, and the medial meniscus is more frequently injured.
Katarina Witt 1988 Costume,
Mundelein School District 75 Salary Schedule,
Articles O
